Author Affiliation: Diabetes Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
The pandemic of diabetes threatens to overwhelm clinicians' collective ability to treat the associated metabolic abnormalities and long-term complications. Yet even in the setting of the pandemic, clinical research has yielded remarkable progress that has improved the long-term prognosis of diabetes.
The Diabetes Control and Complications Trial (DCCT) and its long-term follow-up definitively established hyperglycemia as the—or at least a—major cause of complications of diabetes by demonstrating that intensive therapy achieving a glycated hemoglobin (HbA1c) level of approximately 7% reduced the development and progression of retinopathy, nephropathy, and neuropathy by 30% to 76%, compared with conventional treatment that achieved an HbA1c level of approximately 9%.1 The long-term follow-up results have demonstrated that the relative benefits of intensive therapy persist for at least 10 years after the end of the intensive intervention, even after the HbA1c levels in the treatment groups converged, a phenomenon termed “metabolic memory.”2,3 Long-term follow-up also showed that intensive therapy was associated with a 57% reduction in cardiovascular disease.4
Nathan DM. Progress in Diabetes Research—What's Next. JAMA. 2009;301(15):1599-1601. doi:10.1001/jama.2009.509